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Posterior Lumbar Fusion
The posterior approach to lumbar spinal fusion is done from your back. This approach can be just a fusion of the vertebral bones or it can include removal of the problem disc.
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One of the main goals of any surgical procedure on the skeletal system is to stop the pain caused by joints that have worn out over time-degenerative joints. One of the most reliable ways to reduce pain from degeneration is to fuse the joint together. A fusion is an operation where two bones, usually separated by a joint, are allowed to grow together into one bone. The medical term for this type of fusion procedure is arthrodesis.
Spinal fusion has been used for many years to treat painful conditions in the lumbar spine. Over the past decade, there have been dramatic improvements in the way that spinal fusion operations are performed. One major improvement has been the development of fixation devices.
Only when all other conservative treatments have failed will your doctor suggest fusion surgery. Several back conditions may require a spinal fusion, including
- Degenerative disc disease
- Spinal instability
- Spine curvature
- Spondylolysis and spondylolisthesis
- Spinal injury
The posterior approach is done from the back of the patient. This approach can be just a fusion of the vertebral bones or it can include removal of the problem disc. If the disc is removed, it is replaced with a bone graft, or an interbody fusion device. The surgeon moves the spinal nerves to one side and inserts the bone graft or interbody device between the vertebral bodies. This is called a posterior lumbar interbody fusion.
With a posterior approach, an incision is made in the middle of the lower back over the area of the spine that is going to be fused. The muscles are moved to the side so that the surgeon can see the back surface of the vertebrae. Once the spine is visible, the lamina of the vertebra is removed to take pressure off the dura and nerve roots. This allows the surgeon to see areas of pressure on the nerve roots caused by bone spurs, a bulging disc, or thickening of the ligaments. The surgeon can remove or trim these structures to relieve the pressure on the nerves. Once the surgeon is satisfied that all pressure has been removed from the nerves, a fusion is performed.
Transforaminal Lumbar Interbody Fusion (TLIF)
TLIF is an adaptation of a posterior lumbar interbody fusion. There are several potential advantages of TLIF over the standard posterior approach:
- The procedure can allow your doctor to fuse both the anterior and posterior portions of your spine through a single posterior surgical approach.
- TLIF increases the chance for a successful fusion due to the larger area for bone graft placement. Bone graft can be placed both in the area behind the vertebrae, to the side of the vertebrae, and in the disc space between the vertebrae.
- Because the approach to your disc space and spinal canal with TLIF is from your side, this allows your doctor to perform the operation with minimal stretching of your nerve roots. The exposure of your spinal canal is done from one side only.
- TLIF uses a special spacer called an interbody fusion device that is placed between your vertebrae to help restore the space between the vertebrae (the disc space). This can help reduce irritation and pressure on your nerve roots from bone spurs and thickened ligaments that can be a source of leg pain.
Pedicle Screws and Rods
The surgeon may use some type of metal screws, plates, and rods to hold the vertebrae in place while the spine fusion heals. Designed to stabilize and hold the bones together while the fusion heals, these devices have greatly improved the success rate of fusion in the lower back.
Interbody Fusion Device
A type of device, called an interbody fusion device or cage, can be used to perform a spinal fusion between two or more vertebrae. These implants are designed to spread the two vertebrae apart while the fusion heals.
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IMPORTANT SAFETY INFORMATION
As with any medical treatment, individual results may vary. There are potential risks and recovery takes time. People with conditions limiting rehabilitation should not have this surgery. Only a spine surgeon can tell if spine treatment is right for you.